What are the diagnostic guidelines for Attention Deficit Hyperactivity Disorder (ADHD) in adults?

From the Guidelines

Diagnosing ADHD in adults requires a comprehensive clinical evaluation using the Adult ADHD Self-Report Scale (ASRS-V1.1) as the first step, followed by a detailed assessment of symptoms and history, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1. The diagnosis of ADHD in adults involves several key components, including:

• A thorough clinical interview to assess current symptoms and developmental history
• The use of standardized rating scales, such as the ASRS-V1.1, to evaluate the frequency of symptoms
• A review of the patient's history to identify symptoms that have been present since childhood and occur in multiple settings
• An assessment of the impact of symptoms on daily life and functioning
• The ruling out of other conditions that may mimic ADHD symptoms, such as anxiety disorders, mood disorders, or substance use disorders The DSM-5 criteria for ADHD diagnosis require the presence of at least five inattentive and/or five hyperactive-impulsive symptoms that have persisted for at least six months, are inappropriate for developmental level, and negatively impact social and academic/occupational activities 1. The evaluation process may also involve collateral information from family members, partners, or close friends who knew the person during childhood, as well as school records or workplace evaluations 1. It is essential to note that ADHD symptoms in adults often manifest differently than in children, with less obvious hyperactivity and more problems with executive functioning, time management, organization, and emotional regulation 1. The most recent and highest quality study recommends using the ASRS-V1.1 as a screening tool, with a positive screen defined as four or more symptoms endorsed as "often" or "very often" 1.

From the Research

Guidelines for Diagnosing ADHD in Adults

The diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults involves a thorough clinical interview, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings 2. The following are key points to consider:

• A strong sense of how to proceed with diagnosis using current DSM-IV criteria as a guide 2
• The use of diagnostic and symptom assessment scales to help in diagnosing and establishing the symptoms of ADHD in adults 2
• The importance of remembering that according to DSM-IV, the cardinal criteria for making the diagnosis are the presence of sufficient current symptoms and impairment in two realms (home, school/work, and social interactions) 2
• The publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has provided more clear diagnostic criteria for adult ADHD 3

Key Considerations

When diagnosing ADHD in adults, the following should be considered:

• The poor psychosocial outcomes of patients with ADHD, often a consequence of unrecognized, untreated disorder manifestation, can serve as a diagnostic indicator 2
• Adult ADHD remains a clinical diagnosis, and the clinician-administered interview remains the cornerstone of diagnostic evaluation 2
• Critical differences between childhood and adult ADHD, and specific considerations should be taken with an adult ADHD diagnosis 3
• The successful diagnosis and management of adult ADHD require consideration of many facets including prior medical history and comorbid conditions and use of an individualized, evidence-based treatment approach 3

Diagnostic Criteria

The diagnostic criteria for adult ADHD, as outlined in the DSM-5, include:

• The presence of sufficient current symptoms and impairment in two realms (home, school/work, and social interactions) 2, 3
• The use of rating scales and collateral information to support the diagnosis 2
• The consideration of comorbid conditions and prior medical history in the diagnostic process 3